Summary
Blue Cross and Blue Shield of Nebraska is implementing multiple medical policy changes effective 06/01/2024, including new prior authorization requirements for nerve blocks, Botox/botulinum toxin products with FDA age restrictions, lymphedema/lipedema treatments, radiology codes, and retirement of contact lens/glasses coverage for specific corneal conditions. Additionally, Lumbar Artificial Intervertebral Disc policy (III.170) retires effective 03/22/2024 with CPT codes transitioning to policy III.187.
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What to do
Action · 10 steps
01HISTORICAL MATERIAL DISCOVERED: This policy was published 2024-02-29 and became effective beginning 2024-03-22 (Lumbar Artificial Intervertebral Discs) and 2024-06-01 (remaining policies).
02All stated effective dates have already elapsed as of the analysis date (2026-10-10).
03Billing team should verify current applicability by.
04Confirming whether the practice implemented these policy changes in 2024.
05Checking BCBS Nebraska's current website for any superseding guidance on policies I.212 (Sympathetic Nerve Blocks), I.195 (Botox), III.237 (Lymphedema/Lipedema), IV.81 (Radiology), VIII.2 (Contact Lens/Glasses), and III.170 (Lumbar Artificial Intervertebral Discs).
06Updating billing system workflows if not previously done to enforce prior authorization requirements for affected CPT/HCPCS codes (J0585, J0588, J0586, 74175, 0164T, 0165T, 22857, 22860, 22862, 22865).
07Verifying age-based coverage restrictions for Botox products are correctly configured in the billing system.
08Confirming that ganglion impar blocks are flagged as investigational and that lymphatic physiologic microsurgery procedures are marked investigational.
09Ensuring contact lens/glasses are no longer covered for the six specified corneal diagnoses.
10Contacting BCBS at 1-866-972-9642 (7 a.m.–7 p.m. CST) or visiting RadMD.com if clarification is needed on current policy status.
Codes mentioned
J0585J0588J05867417522857228602286222865
Original notice
MPC February 2024
nebraskablue.com · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of Nebraska changes →MPC February 2024HighEffective Jun 1, 2024 · Medical PolicyMPC November 2021MediumEffective Mar 1, 2022 · Medical PolicyMPC November 2021LowNo effective date · Medical PolicyMPC March 2022MediumNo effective date · Medical PolicyBrowse every Blue Cross Blue Shield of Nebraska change in the policy list